Henrico Police Athletic League
“CHESS CLUB”
Registration Form
The Henrico Police Athletic League is glad to announceits FREEChess Clubfor boys and girls ages 6-18 years old. Participants should be at least vaguely familiar with the game of chess, but this is not mandatory. Informal lessons will be provided to those unfamiliar with the game of chess.The Chess Club will meet on Friday evenings @ 6:30 pm to 8:30 pm at the Henrico County Training Center, located at 7701 E. Parham Rd, Henrico, VA 23228. Registration forms must be completed before participating and can be obtained during Chess Club operating dates and times or by visiting .
Child’s Birth Name ______Nick Name ______
Parents/Guardians______
Address______
Zip Code ______Henrico County Resident______(YES OR NO)
Telephone (H)______(W)______(Cell)______
Emergency Telephone______Emergency Contact Person ______
Date of Birth______Age______(6-18) T-Shirt Size______
School ______
Email address: ______
REGULATIONS:
To be eligible to participate in the “Chess Club” activities, a participant and his/her parent or guardian must completely fill out and properly sign this form attesting that the participant is physically fit for athletic competition and that the parent or guardian consents to such participation. A physical medical examination, while not compulsory, is highly recommended prior to participating in any Henrico PAL sponsored recreation sport program. Accident insurance is recommended for allparticipants in any Henrico PAL sponsored recreation sport program and it is the responsibility of the parent/guardian to provide such insurance.
PARTICIPATION CONTRACT:
We hereby verify that the above information is true and correct, and that (participant’s name) ______is physically fit for the “Chess Club”. We understand that any false information will result in the loss of privileges and immediate suspension from “Chess Club” noted below for the remainder of the year. The participant agrees to comply with the rules and regulations for the recreation sport, recreation facilities and activities as established by the Henrico Police Athletic League.
PARENTAL CONSENT AND WAIVER:
I hereby consent to and approve the above named child to participate in the Henrico PAL “Chess Club”. I understand the risks associatedwith participating in “Chess Club” and hereby waive, for myself and the above named child, any and all claims, demands and right of action against the County of Henrico, and the Henrico Police Athletic League employees, coaches and officials of the league for any injury or accident which may occur to the said child as a result of participating in the program.
The parent(s) and/or guardian(s) consent to and understand that photographs and/or images captured during “Chess Club” participation may be utilized in Henrico PAL literature and advertisement.
*Parent/Guardian Signature______Date______